Prostate Cancer: Caveat Patiens

OK – so my Latin might be rusty, but a question came up this week that will help you understand even better how a patient needs to advocate on his/her own behalf….

I got a call from the mother of a friend of mine. (I’ll call her Jane.) Jane’s husband Max has been diagnosed with prostate cancer and needs a prostatectomy (surgery to remove the prostate). They met with a well-respected surgeon at a well-respected medical center in Boston, and the surgeon recommended he have laparoscopic surgery. The date was set for later in March, and they went on their way.

Since then, Jane and Max have spent some time learning more about prostatectomies and other options, and they came across references to robotic prostatectomies. (As an aside — I actually know a little bit about this robotic surgery since I’ve interviewed two of the surgeons at University Hospital on my radio show who do robotic surgeries, and one of them is a urologist who does these prostatectomies frequently.)

Now Jane and Max are in Florida for a few weeks and last week they went for a second opinion at another very highly respected medical center in Florida. The surgeon there told them more about the robotic prostatectomy option, and Max was pleased at what he heard. In both their minds, it seems like a better option.

So they got back in touch with the Boston surgeon to share their findings — and he tried to steer them away from the robotic surgery option. He told them the laparoscopic surgery was the only recommendation he would make, which, based on what they had learned, just confuses them.

That’s why Jane called me. She already had the answer to this conundrum — she just wanted to check with me to see if she was on the right track. “Is it possible,” she asked me, “That Dr. Boston doesn’t think Max should have robotic surgery because he doesn’t do the robotic surgery himself? And if he doesn’t do it himself, then he won’t make any money from surgery?”

Bingo, Jane!! It does my heart good that you figured this out. Most patients want to think their doctors have their best interests at heart — and many do — but in second place behind their own wish/need/desire to make money. As long as they can make money from you, they have your best interest at heart.

Now — just to be clear — the lesson here is that sometimes there are other motives for a doctor’s recommendation. This does not answer the robotic vs non-robotic question — it just shows that there are very possibly other considerations in the decision-making. My opinion from here is that Jane and Max need to find a doctor who does both the robotic and non-robotic laparoscopic surgeries and get his or her opinion.

In the coming days, I’ll be writing more about this subject — because it’s a biggy, and as I said:

Like this:

4 comments

Hi,
Just wanted to point out that there are options besides ANY form of surgery. These might include radiation (many forms), cryosurgery (freezing), hormone depletion treatment, or even NUTHIN’! Of course, it’s impossible to say which is best for this gentleman. But as you suggest, a lot will depend on which physicians he visits!
hERB

Albert on March 15, 2007 at 3:36 pm

Read Andy Grove’s letter on web. Plus read “surviving prostate cancer without surgery” by Bradley Hennenfent, MD. It is a very serious book, real medicine not alternative one. It actually shows that radiation therapy (like brachytherapy) gives the same survival rate as surgery, but with minimum side effects.The book is very recent gives a full discussion of all possible issues of PC. Andy Grove (intel founder) and Rudi Juliani used radiation therapy. By the way, dr. Krongrad in Aventura, Miami, Fl is famous for his expertise in laparoscopic surgery of PC. I may have the same dilemma. There is also dr. Welsh (John Hopkins hospital) who developped nerve saving operation on prostate, which allows to have erection.
Talk to me if wish.
Albert

I have done hundreds of prostatectomies open, a few laparoscopic, and hundreds robotically.

In my experience at least, I prefer robotics. The 3d visually system, aility to control the camera and 3 other instruments at once, and the natural, intuitive movements of the instruments, allow me to do a better operation. I think a few experienced lap surgeons can do it well, but although I can do a decent lap prostatectomy, I would only do it if my robot failed and I did not have access to another robot. The main reason why is the delicacy of trying to spare the nerves, which I personally do much beter robotically.

As for other surgery like removing a kidney, I prefer to do that robotically but I conceed lap is very close. My only advantage is a more confortable way to operate and it is alittle faster, and possible a little safer.

I think the most important thing is the experience of the surgeon in either case. A robot will not make a surgeon better by itself since it only mimics your hand motions.

You can read more about what I think about asking for a 2nd opinion on my blog (I personally think second opinions are good things):

Please recomend several davinci robot prostatectomy surgeons that you would recommend in the el Paso area (texas, arizona, california) that you would send your first born child to for surgery. I am interested in experience and expertise (as you highlighted). Thank you for your reference (as i know this is a touchy subject). Sincrely and grateful,